Korean J Neurotrauma.  2019 Oct;15(2):176-181. 10.13004/kjnt.2019.15.e33.

Treatment of Pseudoaneurysm of Internal Maxillary Artery Resulting from Needle Injury

• Kim NY
• Kim JY
• Pyen JS
• Whan K
• Cho SM
• Choi JW

• KMID: 2461124
• DOI: http://doi.org/10.13004/kjnt.2019.15.e33

Abstract

Pseudoaneurysm of internal maxillary artery (IMA) after trauma is rare, and most cases reported are caused by maxilla-facial blunt trauma. Pseudoaneurysm is discontinuity in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space producing pulsatile hematoma rapidly. A 44-years-old woman presented with a pulsatile swelling and pain in the left parotid region. She underwent the masticatory muscle reduction using needle injection in dentistry 1 month ago. The left facial pulsatile swelling developed after the procedure immediately and uncontrolled bleeding occurred on the day of visit to our institution. We performed emergency angiography and diagnosed pseudoaneurysm of left IMA. We treated by embolization with Histoacryl Glue through left IMA. IMA total occlusion was confirmed and symptoms improved. Pseudoaneurysm following blunt trauma of the face have been reported but are few. Furthermore, there is no report of IMA pseudoaneurysm due to direct injury by needle. Recently, many cosmetic surgery procedures using injection techniques have been performed, and it is necessary to pay attention to the direct vessel injury by the needle. And endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.

Keyword

Pseudoaneurysm; Internal maxillary artery; Endovascular treatment

MeSH Terms

Adhesives
Aneurysm, False*
Angiography
Dentistry
Emergencies
Enbucrilate
Facial Nerve
Female
Hematoma
Hemorrhage
Humans
Masticatory Muscles
Maxillary Artery*
Needles*
Parotid Region
Surgery, Plastic
Adhesives
Enbucrilate

Figure

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  FIGURE 1 Patient's appearance at the emergency room. Left facial swelling and ecchymosis was seen.

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  FIGURE 2 Neck contrast CT images. (A) Pre-contrast axial, (B) Post-contrast axial, and (C) Post-contrast coronal. CT shows a low-density mass-like lesion at left masticator space with contrast extravasation (arrow).CT: computed tomography.

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  FIGURE 3 Para-nasal sinus CT images. (A) Pre-contrast axial, (B) Post-contrast axial, and (C) Post-contrast coronal. CT shows that Further increased status of previous noted low-density mass-like lesion or loculated fluid at left masticator space but decreased contrast extravasation (arrow).CT: computed tomography.

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  FIGURE 4 Trans-femoral cerebral angiography images. Pre-operative; (A) Antero-posterior view, (B) Lateral view. Contrast filling mass-like pseudoaneurysm was seen in the left IMA proximal area. Post-operative; (C) Antero-posterior view, (D) Lateral view. Left proximal IMA was totally occluded by Histoacryl Glue (arrow).IMA: internal maxillary artery.

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  FIGURE 5 Post-operative patient's appearance at the emergency room. There was seen that decreased left mandibular swelling.

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